Managing Medications: Bipolar Disorder

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Trying to sort through all the different medications available to treat bipolar disorder can be overwhelming. Here, we present a cheat sheet covering the most widely used medications, how they work, their side effects, and some anecdotes from a couple of bipolar patients who have years of experience with a variety of medications. Your doctor may prescribe one or more of any combination of these medicines to help you manage your symptoms. Keep in mind, side effects may go away within a few weeks of starting treatment, and it will likely take some trial and error to figure out which medications are best for each individual.

Lithium

How it works: Lithium affects the nervous system and stabilizes mood, reducing manic episodes. It can also be used as a maintenance medication.

Potential side effects: Hand tremors, diarrhea, increased thirst and/or urination, vomiting, weight gain, poor concentration and memory problems, hair loss, acne, muscle weakness, and thyroid and/or kidney dysfunction.
User experience:

“Lithium gave me hand tremors, but they weren’t too bad.”

Daria Akers, 42, officially diagnosed at age 34.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Common medications: Zoloft, Celexa, Lexapro, Paxil, Prozac and Luvox

How they work: Often prescribed along with lithium or other anti-manic medications, SSRIs are thought to balance out the brain’s serotonin.

Potential side effects: Nausea, agitation or nervousness, dizziness, decreased sexual function, headache, dry mouth, weight gain or loss, drowsiness, insomnia, vomiting, diarrhea.

User experience:

“No ED or anything, but I never ‘got chills’ from [my wife’s] touch, etc., until after I was off [Lexapro].”

Jeff Green,* 38, officially diagnosed at age 21.

Antipsychotics

Common medications: Abilify, Clozaril, Geodon, Risperdal, Seroquel and Zyprexa

How they work: Antipsychotics help balance the brain’s thinking, mood and perception and can help control hallucinations and other symptoms of mania.

Potential side effects: Weight gain, blurred vision, dry mouth, drowsiness, muscle spasms.

User experience:

“Geodon improved my hallucinations a bit, but it makes me tired. I wake up feeling groggy, [I’m] awake for a couple of hours, then I HAVE to take a nap. [It also] made me lose my appetite. Seroquel made me even more tired than Geodon, like a zombie all day, every day. Zyprexa caused extreme weight gain, about 20 pounds in barely a month, and with no improvement in depression.”

Jeff Green

“Zyprexa and Depakote (an anticonvulsant) caused extreme weight gain. I gained 60 pounds in six months. Geodon made me flat; nothing made me laugh or cry.”Daria Akers

Anticonvulsants

Common medications: Depakote, Lamictal and Tegretol

How they work: Originally used to control seizures, anticonvulsants double as mood stabilizers and are often used in the treatment of bipolar disorder. Because they tame hyperactivity, they are good for patients who experience rapid mania cycles.

Potential side effects: Drowsiness, weight gain, dizziness, fatigue, tremor, nausea, rash.

User experience:

“Lamictal helps with hallucinations and depression. It improved my hallucinations more than Geodon. No side effects that I have noticed, really. I’m still on it.”

Jeff Green

“Once my son was born, the hospital pharmacist told me that Lamictal in breast milk can cause babies to stop breathing, so breastfeeding was out. I was crushed. Now I’m on two mood stabilizers, Depakote and Lamictal, and an antidepressant, Lexapro. I feel so different. I can laugh and cry. It feels great.”

Daria Akers

Monoamine Oxidase Inhibitors (MAOIs)

Common medications: Emsam, Marplan, Nardil and Parnate

How they work: Also usually used along with lithium or other mood stabilizers, MAOIs stop the brain’s neurotransmitters from breaking down. They are not prescribed as often because of the interactions they tend to cause with other medications and the risk for high blood pressure.

Potential side effects: Insomnia, dizziness, dry mouth, appetite changes, high blood pressure and/or heart rhythm changes, weight gain, muscle twitching, decreased sexual function.

Calcium channel blockers

Common medications: Diltiazem, Nimodopine and Verapamil

How they work: These medications, usually used for high blood pressure, are still being used experimentally to help treat mania and stabilize mood.

Potential side effects: Headaches, heart rhythm changes, flushing, dizziness, decreased blood pressure, leg swelling, weakness, constipation, tingling.

Benzodiazepines

Common medications: Ativan, Klonipin, Valium and Xanax

How they work: This medication may be good for quick relief from manic symptoms and is often used temporarily, giving a longer-term medication a chance to work.

Potential side effects: Lightheadedness, drowsiness or dizziness, slurred speech, blurred vision, fatigue, muscle weakness, memory loss.

Bottom line:

“Medications all have side effects. You need to balance the side effects you experience with the stability you gain,” says Akers. “Work closely with your doctor to find a set of meds that works to maximize your life. Medications are NOT the complete answer to managing your disease. It is important to pay attention to things like stress, sleep and your general health to successfully live with mental illness.”

*Name has been changed to protect privacy.

SOURCES:

https://www.webmd.com/bipolar-disorder/default.htm

https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

https://www.webmd.com/bipolar-disorder/bipolar-disorder-lithium

https://www.webmd.com/bipolar-disorder/calcium-channel-blockers

https://www.webmd.com/bipolar-disorder/antipsychotic-medication

https://www.webmd.com/bipolar-disorder/bipolar-benzodiazepines

https://www.webmd.com/bipolar-disorder/anticonvulsant-medication

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